CT Perfusion Imaging
Editors
Kenneth A Miles MBBS FRCR MS c MD FCRP
Brighton and Sussex Medical School Brighton
Charles-André Cuenod MD P h D
Laboratoire de Recherche en Imagerie Université Paris V
Paris
France
Foreword by Dame Janet Husband
To Elizabeth, Matthew, Benjamin, and Samuel …
C ontents
C ontributors
Daniel Balvay P h D
Massimo Bellomi MD
Rayleen V Bowman MBBS P h D FRACP
Natalie Charnley MBC h B M R C P FRCR
Xiaogang Chen P h D
Charles-André Cuenod MD P h D
Kwun M Fong MBBS FRACP P h D
Laure Fournier MD P h D
Ethan J Halpern MD
Robert Hermans MD P h D
Michelle Hutnik
Elizabeth P Ives MD
Aliya Jiwani
Ting-Yim Lee P h D FCCPM
William W Li
Anne E Miles BS c PGCE MA
Kenneth A Miles MBBS FRCR MS c MD FCRP
Blake Murphy BS C
Giuseppe Petralia MD
Karim Samji MBBS BS c
Errol Stewart BS C
Ian A Yang MBBS P h D FRACP
F oreword
Professor Dame Janet Husband DBE FMedSci PRCR FRCP
P r eface
Ken Miles MD
P erfusion computed tomography: a historical perspective
ANATOMICAL AND PHYSIOLOGICAL KNOWLEDGE IN ANCIENT CIVILIZATIONS
THE DEVELOPMENT OF MODERN ANATOMY
ANATOMY AND IMAGING
PHYSIOLOGY AND THE CIRCULATION
PERFUSION COMPUTED TOMOGRAPHY: C OMBINING ANATOMICAL IMAGING AND QUANTITATIV
REFERENCES
Scientific basis and validation
DEFINITION OF BASIC TERMS AND DISCUSSION OF FUNDAMENTAL RELATIONSHIPS
T r ansfer flux of solute through the capillary endothelium
C entral volume principle
IMPULSE RESIDUE FUNCTION AND CONVOLUTION
Impulse residue function
C onvolution
F l o w scaled impulse residue function and model deconvolution
C OMPUTED TOMOGRAPHY TUMOR PERFUSION MEASUREMENT WITHOUT THE NEED FOR KINET
F ick principle
No outflow assumption
KINETICS MODELING
C ompartment models
Distributed parameter models
∫ C
INPUT ARTERIAL CONCENTRATION FUNCTION
P a rtial volume averaging
Dispersion of measured arterial concentration function relative to true input
Delay in arrival of contrast agent in tissue relative to the measured arteria
Hepatic artery and portal vein input to the liver
Recirculation
PRACTICAL ISSUES
Scanning protocol: image interval, scanning duration, and radiation dose
C alibration of CT scanner
C ontrast, noise, and radiation dose
V ALIDATION OF COMPUTED TOMOGRAPHY TUMOR BLOOD FLOW AND RELATED MEASUREMENTS
IN ANIMAL TUMOR MODELS
Methods not requiring tracer kinetics modeling
T r acer kinetics modeling methods R3230AC rat-derived mammary adenocarcinom
VX2 brain tumor
VX2 skeletal muscle (thigh) tumor
VX2 liver tumor
V ALIDATION OF CT TUMOR BLOOD FLOW AND RELATED MEASUREMENTS IN CLINICAL STUDI
Reproducibility studies
A ccuracy studies
C ONCLUSION
Image acquisition and contrast enhancement protocols for
CT perfusion
INTRODUCTION AND OVERVIEW:
CT perfusion
IMAGE ACQUISITION
Phase of respiration
Overall length of time of the image series
T he number and frequency of images
T he number and thickness of CT slices
X-ray exposure factors
C ONTRAST ENHANCEMENT
T y pe of contrast medium
V olume and concentration of contrast medium
CHOICE OF PROTOCOL
C OMPARING RESULTS OBTAINED USING DIFFERENT PROTOCOLS
T umor enhancement
C omparing tumor perfusion and enhancement
SUMMARY
REFERENCES
Image processing
DETERMINATION OF AVERAGE MEAN TRANSIT TIME OF A REGION OF INTEREST
IMAGE PROCESSING
Segmentation of specific organs and tumor
Segmentation of vascular structures
Segmentation of different tissue types
C ONCLUSION
A ngiogenesis, tumor perfusion, and cancer management
ANGIOGENESIS IN TUMOR GROWTH, PROGRESSION, AND METASTASES
CHARACTERISTICS OF TUMOR ANGIOGENESIS AND PERFUSION
CANCER MANAGEMENT WITH ANTIANGIOGENIC THERAPY
IMAGING ANGIOGENESIS
F unctional CT
DCE-MRI
MRA
PET
Ultrasound
IMAGING TUMOR VASCULATURE FOR ANTIANGIOGENIC A GENT DEVELOPMENT
C ONCLUSIONS
A CKNOWLEDGMENTS
REFERENCES
T umors of the brain, head, and neck
P a rt A: CT perfusion imaging in cerebral neoplasms
INTRODUCTION
MENINGIOMA
GLIOMA
CEREBRAL LYMPHOMA
METASTATIC BRAIN DISEASE
CT PERFUSION TO DIFFERENTIATE BETWEEN BRAIN TUMOR AND CEREBRAL INFARCTION
THERAPEUTIC PLANNING AND MONITORING
Radiation planning
THERAPEUTIC MONITORING
C ONCLUSION
INTRODUCTION
P a rt B : CT perfusion in head and neck cancer
CT PERFUSION IMAGING IN HEAD AND NECK CANCER
USE OF CT PERFUSION AS PREDICTOR OF LOCAL C ONTROL AFTER RADIOTHERAPY
C ONCLUSION
REFERENCES
CT perfusion applications in lung cancer
P A THOLOGY OF LUNG CANCER
P r esentation
Increasing detection of pulmonary nodules in clinical practice
C ONTRAST-ENHANCED CT
TECHNICAL CONSIDERATIONS: MEASUREMENT OF C ONTRAST ENHANCEMENT AND PERFUSION
EVALUATION OF PULMONARY NODULES
CT enhancement and pathology of lung nodules
C omparison with FDG-PET scans
POTENTIAL LIMITATIONS
V ariations in technique
Enhancing benign lesions
Small nodules
T umoral heterogeneity
P otential technical artifacts
Radiation dose
FUTURE DEVELOPMENTS
Refinements
P r ognostication and treatment monitoring
W hole tumor quantitation
C ONCLUSIONS
REFERENCES
T umors of the gastro-intestinal tract
Part A: Rectal cancer
BACKGROUND
TECHNIQUE
P a tient preparation
Image acquisition protocol
C ontrast medium administration
DATA AND IMAGE ANALYSIS
CURRENT EXPERIENCE AND CLINICAL APPLICATION
C ancer of the pancreas
Part B: Other gastrointestinal tumors
P r imary liver tumors
REFERENCES
T umors of the urogenital tract
PERFUSION IMAGING OF OTHER TUMORS OF THE UROGENITAL TRACT
Renal cancer
C e rvical cancer
REFERENCES
CT perfusion of lymph nodes
INTRODUCTION
L YMPH NODE METASTASES
L YMPHOMA
SUMMARY
REFERENCES
CT perfusion of liver metastases and early detection of micrometastases
INTRODUCTION
LIVER PERFUSION PHYSIOLOGY
QUANTITATIVE MEASUREMENT OF LIVER MICROCIRCULATION WITH FUNCTIONAL CT
Introduction
Different methods for liver perfusion quantification with CT
Slope-ratio methods
T r acer kinetic modeling
Deconvolution method for liver perfusion imaging
Theory of the deconvolution method (see also Chapter 2)
H t h d
Extraction of microvascular parameters
Measurement of the tissue blood flow with the central volume theorem The blo
Extraction of hepatic perfusion parameters
α α
FUNCTIONAL DETECTION OF LIVER METASTASES
CT perfusion and overt metastases
Micrometastases
Relationship between hepatic CT perfusion and survival
Other imaging techniques
Dynamic liver scintigraphy
Duplex Doppler ultrasound
C ontrast-enhanced dynamic MRI
PHYSIOPATHOLOGY OF MICROCIRCULATION ALTERATIONS IN METASTATIC LIVER
In vivo videomicroscopy
LIMITATIONS OF CT PERFUSION IN THE LIVER
C ONCLUSION
REFERENCES
Beyond RECIST: CT perfusion in evaluating treatment r esponse and complicat
INTRODUCTION
CT PERFUSION IN ASSESSING TUMOR RESPONSE TO DRUGS WHICH AFFECT TUMOR VASCULAT
CT PERFUSION IN ASSESSING TUMOR RESPONSE TO NOVEL ANTIVASCULAR AGENTS IN PHAS
CT PERFUSION IN ASSESSING TUMOR RESPONSE TO RADIOTHERAPY
O THER THERAPIES
IDENTIFICATION OF SUBPOPULATIONS ENRICHED FOR RESPONSE
ASSESSMENT OF TREATMENT COMPLICATIONS
C ONCLUSIONS
REFERENCES
P e rfusion CT–PET: opportunities for combined assessment of tumor v ascula
BIOMOLECULAR MEDIATORS FOR TUMOR VASCULARITY AND METABOLISM
V ASCULAR–METABOLIC RELATIONSHIPS IN TUMORS
V ascular–metabolic relationships and tumor aggression
Changes in tumor vascularity and metabolism f ollowing therapy
HEPATIC PHOSPHORYLATION OF GLUCOSE ASSESSED BY CT PERFUSION–PET
SUMMARY
REFERENCES
Index